Provider Demographics
NPI:1841615655
Name:GREWAL, DOLORES (PA-C)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:1 PINE WEST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-582-4414
Mailing Address - Fax:
Practice Address - Street 1:325 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1617
Practice Address - Country:US
Practice Address - Phone:609-921-7411
Practice Address - Fax:609-683-6899
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA056819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant